Cannabis Use Predicts Severe Liver Steatosis in Patients with Chronic Hepatitis C

By Liz Highleyman

A study reported in October 2006* showed that modest use of medicinal cannabis may benefit some patients undergoing treatment for chronic hepatitis C by helping them maintain adherence to combination therapy.

However, some experts expressed concern about hepatitis C patients using cannabis, since a French study of untreated individuals with HCV showed that those who used marijuana daily were more likely to have severe liver fibrosis, and were at higher risk for rapid fibrosis progression, than those who used marijuana only occasionally or not at all.**

At the recent 42nd Annual Meeting of the European Association for the Study of the Liver in Barcelona, Spain, the same research team reported on a study of the link between cannabis use and liver steatosis.

As background, the researchers noted that Cannabis sativa binds to 2 receptors, CB1 and CB2, and recent experimental data suggest that activation of CB1 receptors increases steatogenesis (fat accumulation).

The present study included 311 consecutive treatment-naive patients with histologically proven chronic hepatitis C. The investigators collected epidemiological data; clinical data including body mass index (BMI), diabetes, serum fasting glucose, triglycerides, and cholesterol levels; and recorded intake of cannabis, alcohol, tobacco, and maintenance treatment over the semester preceding liver biopsy. Degrees of steatosis, fibrosis (METAVIR), and histological activity were assessed by 2 pathologists without knowledge of clinical data; marked steatosis was defined as > 30% of hepatocytes.

Results

• Patients (220 men, 91 women, mean age 45 years) were grouped according to frequency of cannabis use:
• non-users (59%);
• occasional users (less than 1 joint daily): 15%, median 4 joints per month;
• daily users (at least 1 joint daily): 26%, median 75 joints per month.
  
  
• In an unadjusted analysis, marked steatosis was associated with frequency of cannabis use, as follows:
• 16.3% in non-users;
• 10.9% in occasional users;
• 30.9% in daily users (P=0.006).
  
  
• Marked steatosis was also associated with:
• BMI >27 kg/m² (29.5% vs 15.9%, P=0.008);
• use of maintenance treatment (39.1% vs 17.7%, P=0.01);
• alcohol consumption of 30 g/day or more (35.7% vs 16.7%, P=0.004);
• genotype 3 HCV (40.0% vs 13.9%, P<0.001);
• hyperglycemia (50.0% versus 20.0%, P<0.001)
• histological activity grade A2 or higher (25.4% vs 10.8%, P=0.001);
• fibrosis stage F2 or higher (29.1% vs 13.9%, P=0.003).
  
  
• In a multivariate analysis, independent predictors of marked steatosis were:
• daily cannabis use (OR=2.13);
• histological activity grade A2 or higher (OR=2.40);
• genotype 3 HCV (OR=4.41);
• hyperglycemia (OR=6.83).

Conclusion

In conclusion, the investigators wrote, “this study discloses a strong link between daily cannabis use and steatosis severity in patients with chronic hepatitis C and supports recent experimental data demonstrating steatogenic effects of CB1 receptors.”

They added that, “These observations, and our previous results showing that daily cannabis smoking is also an independent predictor of fibrosis progression, indicate that patients with untreated chronic hepatitis C should be advised to refrain from daily cannabis use.

04/24/07           

References

C Hezode, ES Zafrani, F Roudot-Thoraval, and others. Cannabis use as an independent predictor of severe steatosis during chronic hepatitis C. 42nd Annual Meeting of the European Association for the Study of the Liver. Barcelona, Spain. April 11-15, 2007.

*DL Sylvestre, BJ Clements, Y Malibu. Cannabis use improves retention and virological outcomes in patients treated for hepatitis C. European Journal of Gastroenterology and Hepatology 18(10): 1057-1063. October 2006.

**C Hezode, F Roudot-Thoraval, S Nguyen, and others. Daily cannabis smoking as a risk factor for progression of fibrosis in chronic hepatitis C. Hepatology 42(1): 63-71. July 2005.

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